The age-specific incidence of admission to the intensive care unit for acute myocardial infarction in Antigua and Barbuda

This study was done to assess the age-specific incidence of admission for acute myocardial infarction in Antigua and Barbuda from 1990 to 2001. A retrospective review of Intensive Care Unit admissions for possible acute myocardial infarction was performed. Data obtained included age, gender, country of residence, electrocardiogram, creatine kinase results and intensive care unit outcome. There were, 250 admissions, 194 (78%) having data available for review. Acute myocardial infarction was found in 107/194 (55.2%) patients, age 59.9 +/- 13.7 years, 28% female, 70% from Antigua and Barbuda, 90/107 (85%) were between 35 and 75 years old. The incidence would be 7.5 per year or 9.7 per year if the confirmation rate documented was similar for all admissions. With a yearly population of 9555 men age 35 to 75 years in Antigua and Barbuda, with men accounting for 72% of acute myocardial infarctions, the incidence rate was 0.57 (confirmed) to 0.73 (all admissions) per year per 1000 men. For women, the yearly population was 10822 age 35 to 75 years, and the incidence rate was 0.19 to 0.24 per year per 1000 women. The mortality rate was 12/107 (11.2%), with women being older (67 vs 57 years, p = 0.001) and dying more often (17% vs 9%) compared with men. The mortality rate in the Intensive Care Unit was 0.07 per year for men, 0.04 per year for women per 1000 aged 35 to 75 years. In the United States of America (USA), the admission rate is 4.1 for men and 1.8 for women per year per 1000 aged 35 to 75 years; the mortality rate is 1.0 for men and 0.5 for women per year per 1000 aged 35 to 75 years. Rates of admission to the Intensive Care Unit for acute myocardial infarction in Antigua and Barbuda are 20%, and mortality rates are 10% of those reported in the USA.

Myocardial infarction in Antigua: 1990 to 1995

Between January 1990 and May 1995, 117 patients were admitted to the Intentsive Care at Holberton Hospital, Antigua, for chest pain due to suspected acute myocardial infarction. 39 (45 percent) of 86 patients whose records were available for retrospective review had confirmed (27 patients) or probable (12 patients) acute myocardial infarction. Risk factors identified among the patients included hypertension, diabetes, tobacco smoking, hypercholesterolaemia and obesity. On admission, 82 percent were Killip class I and 18 percent were Killip class II. Medications in the Intensive Care Unit included nitrates, aspirin, calcium and channel blockers, beta-adrenergic blockers, heparin and angiotensin converting enzyme inhibitors (21 percent). No thrombolytic agents were available. THe average hospital stay was 10 days and the in-hospital mortality rate was 13 percent. These data indicate that early mortality from acute myocardial infarction can be reduced in developing countries by early admission to an Intensive Care Unit and use of drugs known to be effective in its treatment.